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Ann Thorac Surg 2001;71:S232-S235
© 2001 The Society of Thoracic Surgeons

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Valvular bioprostheses over 15 years

Over twenty-year follow-up of the standard Hancock porcine bioprosthesis implanted in the mitral position

^a Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
^b Division of Cardiology, University of Verona Medical School, Verona, Italy

Address reprint requests to Dr Santini, Division of Cardiac Surgery, University of Verona Medical School, Piazzale Stefani 1, 37126 Verona, Italy
e-mail: fsant{at}yahoo.com

Presented at the VIII International Symposium on Cardiac Bioprostheses, Cancun, Mexico, Nov 3–5, 2000.

Background. To define the long-term results of 331 standard Hancock porcine bioprostheses implanted in the mitral position between 1973 and 1980.

Methods. Of 331 patients (225 male patients, 68%), mean age 49 ± 10 years (range 14 to 69 years), 88% were in New York Heart Association functional class III or IV and 77% were in atrial fibrillation. Follow-up time extended more than 20 years (mean 13.9 years, range 0.3 to 24.7 years) for a total of 4,601 patient-years.

Results. Overall operative mortality was 6.3%. At 5, 10, 15, and 20 years, the actuarial survival rate of patients were 71% ± 2%, 46% ± 3%, 30% ± 3%, and 22% ± 2%, respectively. Actuarial estimates of freedom from structural valve deterioration were 95% ± 1%, 67% ± 3%, 32% ± 3%, and 14% ± 3%; from reoperation were 96% ± 1%, 72% ± 3%, 36% ± 4%, and 18% ± 4%; from thromboembolism were 89% ± 2%, 82% ± 3%, 74% ± 4%, and 51% ± 2%; and from anticoagulant-related hemorrhage were 98% ± 1%, 96% ± 1%, 91% ± 1%, and 86% ± 4%. Estimates of freedom from all valve-related mortality at 5, 10, 15, and 20 years were 89% ± 2%, 76% ± 3%, 64% ± 4%, and 48% ± 4%. Multivariate analysis showed younger age to be a significant risk factor for reoperation. Age at operation did not correlate with structural valve deterioration.

Conclusions. The long-term results with the standard Hancock bioprosthesis implanted in the mitral position appear satisfactory, particularly up to 15 years from implantation. Protection from stroke, anticoagulant hemorrhage, and endocarditis was good.

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